糖尿病患者肾病预测中的肾小球高滤过：一项10年随访研究。

Glomerular hyperfiltration in the prediction of nephropathy in IDDM: a 10-year follow-up study.

作者信息

Yip J W, Jones S L, Wiseman M J, Hill C, Viberti G

机构信息

Unit for Metabolic Medicine, United Medical and Dental Schools, Guy's Hospital, London, U.K.

出版信息

Diabetes. 1996 Dec;45(12):1729-33. doi: 10.2337/diab.45.12.1729.

DOI:10.2337/diab.45.12.1729

PMID:8922358

Abstract

Glomerular hyperfiltration has been proposed as an independent risk factor for the development of diabetic nephropathy in patients with IDDM. In a case-controlled prospective study of IDDM patients without albuminuria, serial glomerular filtration rate (GFR) measurements were performed over an observation period of 10 years. A group of 25 IDDM patients (20 men, 5 women; initial age, 29 [17-49] years) with glomerular hyperfiltration (GFR >135 ml x min(-1) x 1.73 m(-2)) were matched for age, sex, and duration of diabetes with 25 IDDM patients (20 men, 5 women; initial age, 30 [17-48] years) with glomerular normofiltration (GFR 83-135 ml x min(-1) x 1.73 m(-2)). GFR, urinary albumin excretion rate (AER), blood pressure, and glycated hemoglobin were measured at baseline and at 5, 8, and 10 years. The two groups had similar entry levels of blood pressure, AER, and glycated hemoglobin. Metabolic control was similar in the two groups during follow-up. The final GFR remained higher in the group with hyperfiltration (122 [109-135] vs. 103 [95-111] ml x min(-1) x 1.73 m(-2); P = 0.02) despite a nonsignificantly faster rate of fall of GFR compared with that of the control group (2.54 [1.20-3.88] vs. 1.50 [1.01-1.99] ml x min(-1) x year(-1); P = 0.14). A similar number of patients in each group progressed to either microalbuminuria or macroalbuminuria (n = 4 vs. n = 3) or developed hypertension (blood pressure, >160/95 mmHg; n = 3 vs. n = 4). End-of-study AER was, however, higher in the group with hyperfiltration (geometric mean [95% CI]: 18.9 [11.3-31.6] vs. 11.0 [8.1-15.0]; P = 0.05), and baseline glomerular hyperfiltration was an independent determinant of end-of-study blood pressure (P = 0.04). The strongest predictors of end-of-study AER and blood pressure were their baseline values (P < 0.04 and P < 0.01, respectively). In conclusion, levels of AER and blood pressure are the main risk factors for renal outcome, while glomerular hyperfiltration appears to play a lesser role.

摘要

肾小球高滤过已被认为是胰岛素依赖型糖尿病（IDDM）患者发生糖尿病肾病的一个独立危险因素。在一项针对无蛋白尿的IDDM患者的病例对照前瞻性研究中，在10年的观察期内对患者进行了系列肾小球滤过率（GFR）测量。一组25例肾小球高滤过（GFR>135 ml·min⁻¹·1.73 m⁻²）的IDDM患者（20例男性，5例女性；初始年龄29[17 - 49]岁），在年龄、性别和糖尿病病程方面与25例肾小球滤过正常（GFR 83 - 135 ml·min⁻¹·1.73 m⁻²）的IDDM患者（20例男性，5例女性；初始年龄30[17 - 48]岁）相匹配。在基线以及第5、8和10年时测量GFR、尿白蛋白排泄率（AER）、血压和糖化血红蛋白。两组的血压、AER和糖化血红蛋白的初始水平相似。随访期间两组的代谢控制情况相似。尽管与对照组相比，高滤过组GFR下降速度略快但无显著差异（2.54[1.20 - 3.88] vs. 1.50[1.01 - 1.99] ml·min⁻¹·年⁻¹；P = 0.14），但高滤过组的最终GFR仍较高（122[109 - 135] vs. 103[95 - 111] ml·min⁻¹·1.73 m⁻²；P = 0.02）。每组进展为微量白蛋白尿或大量白蛋白尿的患者数量相似（n = 4 vs. n = 3），或发生高血压（血压>160/95 mmHg；n = 3 vs. n = 4）。然而，高滤过组研究结束时的AER更高（几何均值[95%CI]：18.9[11.3 - 31.6] vs. 11.0[8.1 - 15.0]；P = 0.05），并且基线肾小球高滤过是研究结束时血压的一个独立决定因素（P = 0.04）。研究结束时AER和血压的最强预测因素是它们的基线值（分别为P < 0.04和P < 0.01）。总之，AER和血压水平是肾脏预后的主要危险因素，而肾小球高滤过似乎起的作用较小。